Membership Form - The Strategic Alliance Group

Strategic Alliance Group Membership Application

Please take your time going through this appication, and feel free to save for later if needed.

Personal Information

First Name *

Last Name *

Professional Title *

Company Name *

Phone *

Work Phone / Other Phone Number

Work Email Address *

Who Were You Invited You? *

Industry *

Is this your full time / primary occupation? *

Product or Service Description *

Industry and Current Position Experience

Length of experience in your profession *

Length of experience with your current company *

Relevant Licenses, Certifications, and/or Degrees held

Have you ever had a license or certification revoked, or been found guilty of a felony? *NoYes

Please provide us with more details about your answer to the question above.

Anything else you want us to know about your professional experience?

Please provide two relevant work references.

A referral partner or client is preferred. Our membership committee will reach out to the references listed below. Please let them know to expect to hear from us.

Reference #1: Full Name *

Reference #1: Company *If reference is a client, simply enter "client" here.

Reference #1: Position *

Reference #1: Best Contact Number *

Reference #1: Email Address *

Reference #2: Full Name *

Reference #2: Company *If reference is a client, simply enter "client" here.

Reference #2: Position *

Reference #2: Best Contact Number *

Reference #2: Email Address *

Commitment Agreement

Can you commit to attend weekly meetings? *YesNo

Are you willing to send a substitute if you are unable to attend a meeting? *YesNo

Are you a member of any other networking organizations? *YesNo

Please provide the names of other networking organizations you are an active member of. *

How do you believe you will benefit from your membership in SAG?

How might other members benefit from your membership in SAG?

Thank you for your interest in our group.

We will be in touch with you shortly to discuss next steps. Please sign below to acknowledge, then click to submit your application.

The information I have provided on this form is true and accurate to the best of my knowledge. *

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